Editorial feature: Horse doctoring & the ethical evolution of veterinarians
From ANIMAL PEOPLE, April 2013:
By Merritt Clifton & Kim Bartlett
The American Veterinary Medical Association, 150 years old this year, has from the beginning pitched a broad tent. The AVMA is at once a trade association representing the economic concerns of veterinarians; a professional body setting veterinary standards; an umbrella for ongoing efforts to advance veterinary science; a provider of continuing professional education to vets; a disaster relief agency; a provider of public education about animal issues; and an entity which seeks to influence public policy. Frequently these roles are in conflict. AVMA position statements, reflecting the views of the members who elect the AVMA House of Delegates, have often been at odds with advances in scientific recognition of animal intelligence and sensitivity to pain. AVMA policy recommendations are also at times decades behind public opinion. Purporting to advocate for animal welfare, the AVMA in truth has a long history of advocating chiefly for veterinary self-interest and the interests of the animal use industries. Founded at the Astor House in New York City as the United States Veterinary Association, with 40 charter members, the AVMA originated coincidental with the emergence in the U.S. of widespread public concern for animal welfare. Henry David Thoreau, nine years earlier, mentioned an otherwise unknown anti-hunting humane society in his 1854 opus Walden. Five years earlier, in 1858, Elizabeth Morris and Annie Waln founded the Animal Rescue League of Philadelphia, a direct ancestor of both the Morris Animal Refuge and the Women’s Humane Society, and indirectly ancestral as well to the Pennsylvania SPCA and the American Anti-Vivisecton Society. Henry Bergh founded the American SPCA in 1866 at Clinton Hall, on Astor Place. But, though the AVMA and ASPCA emerged almost next door to each other, three years apart, newspaper coverage of their founding indicates little recognition of common purpose. The first missions of the ASPCA were to reform New York City animal control and to improve the treatment of working horses. The first problem confronted by the U.S. Veterinary Association was to decide who should be considered a veterinarian. Traditionally, most people providing health care to animals developed their skills through apprenticeship, usually to a farrier––then just a blacksmith skilled at making horseshoes. The very term “farrier” means simply “iron worker.” Though typically calling themselves “horse doctors,” few proto-veterinarians had much formal education. Academic veterinary education originated at the University of Lyon, France, in 1764. The Alfort Veterinary School in Paris opened a year later. The University of Vienna started a veterinary school in 1767, and the Royal Veterinary College of London opened in 1791, but the first vet school in North America was the Autonomous National University of Mexico, founded in 1853. The Boston Veterinary Institute, the first in the U.S., opened in 1855. The vet school at Guelph University in Ontario, Canada, debuted in 1862. Few participants in organizing the U.S. Veterinary Association held any sort of directly relevant degree. One who did, however, was 28-year-old Alexandre Liautard (1835-1918), a recent Alford graduate who also earned a U.S. medical degree, and was elected first president of the U.S. Veterinary Association. Liautard in 1877 founded the American Veterinary Review, ancestral to both the Journal of the American Veterinary Medical Association and the American Journal of Veterinary Research. In that capacity Liautard translated several of the most important writings of pioneering immunologist Louis Pasteur (1822-1895) for American readers. This in 1886 brought Liautard into conflict with Henry Bergh. Summarized John D. Blaisdell in a 1996 review of “The American Veterinary Community’s Reception of Pasteur’s Work on Rabies,” published by the journal Agricultural History, “Bergh believed the incidence of rabies was overblown. Furthermore, he had doubts about Pasteur’s work, especially that Pasteur had not identified the causative organism of the disease.” Bergh in his zeal to defend dogs from persecution tended to disregard findings derived from animal experiments. His public rejection of the principles of vaccination as discovered by Pasteur and explained by Liautard might be seen as the origin of fractious relations between the humane and veterinary communities, except that Bergh’s view of vaccination in the short term prevailed among U.S. vets. The U.S. Veterinary Association annual meeting of 1887 adopted resolutions rejecting vaccination and “favoring the destruction of all animals exposed to, or having disease,” reported the Atlantic Daily Telegraph. This was not actually what Bergh wanted, either, but it prevails to this day as the “stamping out” response to animal disease outbreaks practiced throughout the world. Only within the past decade have the Organization for Animal Health (OIE), United Nations Agricultural Organization (FAO), and World Health Organization come to accept Liautard’s preference for prophylactic vaccination. As late as 1908 the AVMA was still split over whether vaccination should be used at all. In 1907 the USDA introduced a vaccine against hog cholera. Discovered in southern Ohio in 1833, hog cholera outbreaks had killed 13% of the pigs in the U.S. in 1886-1887 and again in 1896. The AVMA resisted recommending the vaccine, however, preferring to try to treat infected pigs by forcing cheap bourbon down their throats. Six generations of improved vaccines later, the USDA at last eradicated hog cholera in 1978, after a 17-year effort mandated by federal legislation. Dean of the New York University Veterinary College for 25 years, 1868-1893, Liautard eventually retired back to Paris, after which the institution became the New York State College of Veterinary Medicine at Cornell University in Ithaca. Long outliving all of the other AVMA cofounders, Liautard nearly survived the deprivations of World War I as well, but died in 1918, shortly before the fighting ended. Dual-value ethic As Liautard discovered to his frequent frustration, a dual-value ethic was built into the veterinary profession long before it had educational institutions, any support from scientific research, or had a name more elegant than “horse doctor.” The original subjects of most veterinary care were mostly working animals––especially horses, donkeys, and mules. These occupied an intermediate status between pets in the modern sense, which relatively few people kept in the 18th and early 19th centuries, and livestock raised for meat. Horses, donkeys, and mules were usually worked hard and long, and sometimes flogged, as is still their lot in much of the developing world, while livestock before the advent of factory farming spent most of their time at pasture, leading semi-natural lives. But, because horses, donkeys and mules had to be laboriously trained to work, and were typically kept for many years, money was spent on them for farrier and veterinary care long before most people who kept animals spent any money on maintaining the well-being of other species. Though Renaissance paintings document some exceptions, most kept dogs until less than 100 years ago were hunting or herding dogs, who were typically treated as expendable commodities. Most cats were semi-feral. The rise of pet-keeping coincided with the rise of the veterinary profession in Victorian times, but veterinarians did not become much interested in dogs and cats until the mid-20th century. The AVMA did not adopt a professional oath until 1969, and did not add obligations to protect animal welfare and prevent animal suffering to it until 2010. By then most veterinarians––and veterinary students––had for more than half a century found themselves in effect having to choose which way to ride from a professional crossroads, away from horse-doctoring into distinctly different specialties. As horses were by the early 1920s disappearing from transportation and farm work in the U.S., for vets to remain focused on traditional horse-doctoring was barely even an option. Some vets might make a living treating riding and carriage horses, and/or race horses, but most vets in most of the U.S. had to learn how to treat other species, and had to find clients willing and able to pay for the treatment.
In the direction taken by most, into agricultural practice and laboratory animal research, the animals were vastly more numerous and the customers fewer. Each animal had much less individual value than was accorded to working horses before the advent of automobiles. In either agriculture or laboratory animal research, the veterinary goals, both then and now, are focused on maintaining herd or flock health, rather than on the well-being of individual animals. This mostly amounts to preventing the spread of contagious disease. As veterinary understanding of bacteria and viruses increased, agricultural vets followed the lead of lab vets in introducing intensive confinement, isolation barns, and prophylactic use of antibiotics. Agricultural vets also introduced the use of steroidal growth stimulants, recycling animal protein into feed for ruminants, gestation stalls, and most of the other practices which are together called “factory farming.” The term “factory farming” was initially used as a compliment to the new approaches, since factories were widely believed to be models of efficiency, leading the world from poverty to abundance. Vladimir Lenin and Josef Stalin hoped to make the Soviet Union the world leader in introducing industrialized agriculture, initiating an economic and technological rivalry with U.S. agribusiness that included parts of the 1958 “Kitchen debate” between then-U.S. vice president Richard Nixon and then-Soviet premier Nikita Krushchev. Conceding that the U.S. had taken the lead in some aspects of technology that he considered less important than agriculture, Krushchev asked if the U.S. had also developed a machine that “puts food into the mouth and pushes it down.” The numbers of dogs and cats whom vets might treat during the era of transitioning away from equine use in work and transport were far fewer than farmed animals. Despite the more than tenfold increase in the volume of pets kept from the mid-1920s until today, the combined U.S. dog and cat population is still less than the numbers of cattle and pigs on farms at any given time. Potential paying customers for pet care, however, were more numerous even in the 1920s than were farmers and laboratory directors, and the animals treated often had much higher individual value to the clients than horses. Indeed, horses were sold to slaughter in vastly greater numbers from circa 1920 until circa 1960, at lower prices per pound of flesh, than at any time since. In agricultural and laboratory practice, surgical skills might be used, for instance in castrating and tail-docking piglets, but most agricultural and lab vets do little surgery. Dog-and-cat practice, however, from the beginning focused on surgery. Other companion animals, such as birds, rabbits, rodents, and reptiles, were seldom seen by veterinarians until recent decades; treating them, and treating wildlife and zoo animals, did not emerge as recognized veterinary specialties, with full-time practitioners, until the 1970s. The first problem for dog-and-cat vets in the 1920s was finding procedures to perform. The AVMA in 1923 approved and advocated dog and cat sterilization surgery to prevent overpopulation. The American Humane Association, however, at that time the only U.S. humane organization with a national presence, then supervised and partially operated the orphanage system for New York state. Under AHA management was the largest orphanage in the U.S., housing 10,000 children on the premises of the Mohawk & Hudson Humane Society in Albany, near the original AHA headquarters. Battling eugenicists who favored forcibly sterilizing the poor, the AHA board believed that accepting sterilization of dogs and cats would set a bad precedent for sterilizing the girls in their care. The AHA denounced dog and cat sterilization as an alleged money-grubbing scheme advanced by vivisectionists, reiterated that perspective as recently as 1968, and did not grudgingly rescind opposition to dog and cat sterilization until 1973, by which time practically everyone had forgotten why the AHA initially took the position that it did. Indeed, the AHA did not actually oppose vivisection, either in 1923 or later, though it did oppose classroom dissection as soon as it was introduced. Originally an organization whose policies and officers were elected by the national membership, the AHA at one point even expelled antivivisection societies from eligibility to become members.
The AVMA meanwhile reinforced humane skepticism of dog and cat sterilization by introducing dog devocalization in 1925. For years thereafter the AVMA annual conferences featured floor demonstrations of devocalization, along with demonstrations of tail-docking, ear-cropping, and declawing cats, which involves amputating portions of the cats’ paws. The AHA immediately condemned these procedures as inhumane, not least because the AHA executives recognized that the latter three were adapted from common practices of dogfighters––tail-docking and ear-cropping to give an opponent fighting dog less to grab, declawing to prevent a cat used as live bait from injuring the fighting dog. The AVMA now discourages devocalization, tail-docking, ear-cropping, and declawing cats, but only ear-cropping is discouraged unequivocally, whereas all four procedures are illegal and can be cause for stripping a veterinarian of credentials in many other nations. Ironically, after failing for more than 30 years to sell the humane community on the advantages of dog and cat sterilization, the AVMA later became the leading and most aggressive opponent of high-volume, low-cost sterilization surgery. Friends of Animals opened the first low-cost sterilization clinic in the U.S. in 1957, in Neptune, New Jersey. The Long Beach SPCA, of California, was by 1958 sterilizing all dogs and cats before adoption. From then to now, the organized veterinary profession has vigorously opposed the opening and expansion of high-volume, low-cost sterilization clinics; opposed the operation of sterilization clinics by nonprofit humane societies; opposed early-age dog and cat sterilization; opposed differential dog licensing, which means that sterilized dogs are licensed for a lower fee than those who are intact; and opposed neuter/return feral cat control. The AVMA itself has not led most of the opposition in recent years, but neither has it stood up prominently against entities such as the Alabama Veterinary Practice Owners Association and the South Carolina Veterinarians Association. The former in 2012 unsuccessfully pushed legislation which would have closed all four nonprofit sterilization clinics in Alabama. The latter is currently pushing a bill to limit the care that can be provided by humane society vets to sterilizing animals and emergency aid. Most advances in controlling dog and cat overpopulation have been perceived by vets as threats to their income, and still are, despite a wealth of evidence accumulating all the while that sterilized pets are valued more, kept longer, and taken far more often for other veterinary treatment. This includes geriatric care, which for more than 20 years has documentedly accounted for more than half of the lifetime veterinary expense incurred by pets who live to at least age 10. Neuter/return appears to be viewed with suspicion by the AVMA perhaps because sterilizing feral cats for neuter/return programs is a big part of the work of many nonprofit clinics. The AVMA position statement on “Free-roaming Abandoned and Feral Cats” currently states that, “The AVMA neither endorses nor opposes appropriately managed cat colony programs,” but contends that “An insignificant percentage of the total number of unowned free-roaming and feral cats are being managed by humane organizations. Consequently, the reduction in the total number of free-roaming cats these programs will effect is insignificant.” This contention is presented without any supporting data as to either how many feral cats exist or how many are in colonies managed by humane organizations. It ignores that the numbers of cats killed in U.S. animal shelters fell by approximately 75% within 10 years of the introduction of neuter/return in 1991-1992. It disregards that the members of Alley Cat Rescue alone are currently sterilizing about 45,500 feral cats per year, working in 37 states––and Alley Cat Rescue is just a fraction of the size of Alley Cat Allies, the largest U.S. organization promoting neuter/return, with members directing neuter/return programs in 46 states. The AVMA position against legislation to mandate sterilization of pit bulls is subsumed within the assertion that, “Banning specific breeds to control dog bite injuries ignores the scope and nature of the problem and is unlikely to protect a community’s citizens.” This claim is, first of all, blatantly false. In truth, the few large U.S. cities which prohibit or restrict possession of pit bulls have had markedly fewer dog attack fatalities and disfigurements over the past 30 years than any others of comparable size. Also of note is that these cities––San Francisco, Denver, Miami, and New York City––impound and kill just a fraction as many pit bulls as those without breed-specific laws. Bluntly put, the AVMA appears to oppose breed-specific legislation by way of pandering to the same “fanciers” who popularized “cosmetic” surgeries and were long a big part of many veterinarians’ clientele, even if they didn’t have many dogs neutered. Though dogs have bred prolifically without human help since long before the rise of human civilization, canine obstetrics has become a lucrative branch of the veterinary industry, for example because dogs often need help to birth breeds with disproportionately large heads.
Changing ethical outlook
Along the way, the demographics of the veterinary profession have shifted several times. Because initially there were far more jobs in agriculture and laboratory animal care, most veterinarians initially chose those career directions until relatively late in the 20th century. Because there was a shortage of small animal vets, veterinarians from agricultural and laboratory backgrounds were frequently hired, later in their careers, to run animal shelters. This contributed to the institution of high-volume killing as the primary response of the humane community to dog and cat overpopulation, though the AHA rejection of sterilization surgery and widespread fear that impounded animals might be used in laboratories via “pound seizure” were also major factors. Yet the 1963 introduction of the AVMA Guidelines for the Euthanasia of Animals, the 2013 edition of which is reviewed elsewhere in this edition of ANIMAL PEOPLE, marked the first steps toward the abolition of killing shelter dogs and cats by decompression, drowning, gunshot, carbon monoxide gassing, and lethal injections of magnesium sulfate and T-61––all common then, but now mostly history in the U.S., though still used abroad. In this area the AVMA was well ahead of much of the animal sheltering portion of the humane community. In addition, the agricultural emphasis on disease suppression contributed to reorienting the position of the humane community from denying the prevalence of rabies, as Henry Bergh had, toward helping to eradicate canine rabies from the U.S., by emphasizing the importance of vaccinating every dog and cat. The composition of the veterinary profession meanwhile changed and changed again. First, as the numbers of jobs in dog and cat practice increased, more vets came out of urban rather than rural and agricultural backgrounds, and female vets came to outnumber males in companion animal work. By the early 21st century, while veterinary shortages afflicted all sectors worldwide, laboratories serving public health agencies, in particular, began to recruit vets from companion animal welfare backgrounds. Many of these vets participated in identifying and tracing back to source a series of zoonotic disease outbreaks which jumped into humans from factory-farmed animals, for example mad cow disease, Severe Acute Respiratory Syndrome, and the H5N1 avian influenza. This brought thousands of vets with the one-to-one doctor/patient outlook of a physician to reappraise agricultural practices which were mostly designed by veterinarians with the outlook of factory farmers. Many of the veterinary engineers who developed and advanced factory farming are now experiencing future shock from discovering that their several generations of apparent success are no longer acclaimed and praised. Instead, factory farming is increasingly professionally recognized and blamed for creating new and worse epidemiological problems. Feeding prophylactic doses of antibiotics to livestock and poultry, in particular, caught on because preventing even very mild bacterial infections enables animals to divert calories from fighting infection to growing faster. This practice is now widely condemned for having caused common bacteria to become resistant to antibiotics, so that diseases once believed to have been almost eradicated are again common, and more deadly than ever. Veterinarians who thought of themselves as helping to feed the world now find themselves blamed for contributing to global pandemics, environmental degradation, and climate change. Animal agriculture itself is increasingly recognized as a source of world hunger, unviable even at the present level in a warmer world. And these same vets are seeing the practices that they developed, introduced, and advanced assailed from within the veterinary profession for being inhumane. Adding the obligations to protect animal welfare and prevent animal suffering to the veterinary oath may help to resolve the conflict of veterinary outlooks somewhat––especially among the next generation of vets. Perhaps within another decade or two the AVMA will at last be ready to condemn the many factory farming practices that are already rejected by much of the public and, responding to public concern, much of the retail food industry. Meanwhile, the veterinary profession appears to be returning to the crossroads it reached about 90 years ago, with a new consideration added. Instead of merely considering what to do if not practicing as “horse doctors,” veterinarians have begun pondering whether any approach to veterinary medicine should be considered humane if it gives more consideration to the economic aspects of the vet/client business relationship than to doing what is best for the individual animal.